Infection of the gastric mucosa by Helicobacter pylori remains a worldwide problem and contributes to peptic ulcer disease and gastric cancer. Without active intervention, at least 20% of the population of developed countries will continue to be infected by this gastric pathogen. Eradication of the organism would contribute to prevention of disease. Current eradication requires triple therapy, a proton-pump inhibitor and two antibiotics given twice a day for 10 to 14 days. Resistance to either clarithromycin or metronidazole is >20% and rising. No monotherapy is effective. Gastric infection by H. pylori depends on the expression of a channel unique to this pathogen, UreI. UreI is a proton-gated urea channel necessary for rapid access of urea to intrabacterial urease, essential for maintaining the periplasm at pH 6.1 in the acidic environment of the stomach, as low as pH 2.5, thus allowing colonization of the stomach. Expression of the channel is increased in the stomach. The channel has 193 residues with six transmembrane segments and three periplasmic regions. Mutagenesis studies have shown that the proton gating of UreI is regulated by hydrogen bonding between histidines and carboxylic acid residues in these three periplasmic regions. Obtaining a high-resolution 3-dimensional structure of this channel is the major goal of this work. This will enable understanding of the unique proton-gating mechanism of this protein and will provide a structure to which inhibitors, some of which have been discovered already, can be docked and their structure-activity relationship identified. Inhibition of this channel would be expected to result in specific and effective monotherapy for eradication of the organism and usher in an era of test and treat, rather than only treating symptomatic patients. This would provide a preventive approach to serious upper gastro-intestinal diseases, particularly gastric cancer. PUBLIC HEALTH RELEVANCE Infection of the human stomach by Helicobacter pylori remains an unresolved problem in both the West and underdeveloped countries. Infection increases the risk of developing gastric cancer about 20-fold. Current eradication therapy is cumbersome, requiring twice-a-day administration of a proton-pump inhibitor and two antibiotics. A high-resolution structure of the proton-gated urea channel, UreI, will provide a template for the development of inhibitors that will allow simple targeted monotherapy, allowing a test and treat strategy worldwide to prevent peptic ulcer disease and reduce the incidence of gastric adenocarcinoma.